New findings on alternative criteria for PTSD in preschool children

J Am Acad Child Adolesc Psychiatry. 2003 May;42(5):561-70. doi: 10.1097/01.CHI.0000046822.95464.14.


Objective: An alternative set of criteria for posttraumatic stress disorder (PTSD) for preschool children was analyzed for validity.

Method: Sixty-two traumatized children and 63 healthy controls, aged 20 months through 6 years, were assessed. The traumatic experiences included motor vehicle collisions, accidental injuries, abuse, and witnessing violence. The number of symptoms required for clusters C and D and the utility of proposed symptoms were systematically analyzed.

Results: No cases met the DSM-IV algorithm for PTSD. Cluster B was endorsed 67.9% of the time. The proportion of cases meeting the cluster C threshold was 2% when three symptoms were required, 11% when two symptoms were required, and 39% when one symptom was required. The rate of cluster D was 45% when two symptoms were required and 73% when one symptom was required. Four novel symptoms did not substantially add to the diagnostic validity of the criteria. The optimal algorithm (one cluster B symptom, one cluster C symptom, and two cluster D symptoms) diagnosed PTSD at a rate of 26%. Measures of comorbid symptoms concurrently provided convergent validation to support this revised algorithm.

Conclusion: Revisions to the DSM-IV PTSD criteria continue to be supported so that highly symptomatic young children can be diagnosed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Algorithms
  • Child
  • Child, Preschool
  • Cluster Analysis
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Infant
  • Life Change Events
  • Male
  • Psychiatric Status Rating Scales
  • Reproducibility of Results
  • Stress Disorders, Post-Traumatic / diagnosis*